Gastroenterology & Hepatology MCQs

Medicine · 5 free questions with answers & explanations.

1. A 45-year-old woman with known primary biliary cholangitis on ursodeoxycholic acid presents with worsening pruritus and fatigue. Labs show ALP 420 U/L, GGT 310 U/L, total bilirubin 2.1 mg/dL, and positive anti-mitochondrial antibodies. She has an inadequate biochemical response to UDCA after 12 months. Which agent is MOST appropriate to add?
2. A 52-year-old man with decompensated alcoholic liver cirrhosis presents with fever, abdominal pain, and worsening ascites. Diagnostic paracentesis is performed. Which single ascitic fluid finding is MOST diagnostic of spontaneous bacterial peritonitis (SBP)?
3. A 38-year-old man presents with a 6-month history of episodic crampy lower abdominal pain, diarrhea, and a 5 kg weight loss. Colonoscopy shows skip lesions, cobblestone mucosa, and a fistulous tract between the terminal ileum and sigmoid colon. Biopsy reveals transmural granulomatous inflammation. He is started on corticosteroids. For long-term disease control and fistula healing, which is the MOST appropriate maintenance therapy?
4. A 60-year-old obese man with type 2 diabetes presents for evaluation of persistently elevated liver enzymes (ALT 78, AST 62 U/L) for over a year. Alcohol intake is negligible. Hepatitis B surface antigen and anti-HCV are negative. Liver ultrasound shows increased echogenicity. Liver biopsy reveals steatosis (> 5%), lobular inflammation, ballooning hepatocytes, and perisinusoidal fibrosis (stage 2). Which finding on biopsy most strongly predicts progression to cirrhosis?
5. A 70-year-old woman presents with painless jaundice, pruritus, and a 10 kg weight loss over 3 months. On examination, a non-tender, palpable gallbladder is noted. Serum bilirubin is 12 mg/dL (predominantly conjugated), ALP 680 U/L. Abdominal ultrasound shows dilated intrahepatic and extrahepatic bile ducts with a mass at the head of pancreas. What eponymous sign explains the palpable non-tender gallbladder in this setting?